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Poster: Arbuthnot Date: Jan 2, 2008 3:58pm
Forum: GratefulDead Subject: Re: gas and a pack of smokes

J. ... i most definitely am not qualified to debate seriously the merits or faults of the healthcare system here in the US, or what is available abroad in Europe, however, working in healthcare myself, the quality and availability of one's healthcare is largely defined according to the region and/or state that one lives in, much in the same way that public education is better in some places than in others; and given that much of my extended family lives in Ireland/England, i know that any of my relatives who can afford it, purchase private healthcare (by no means cheap by the way), which gives them access to an entirely different level of healthcare than those who must resort to what is provided by the gov't; here in the northeast, i must admit that i have access to excellent healthcare; is everyone provided for? no, but that is a question/issue of an entirely different nature

This post was modified by Arbuthnot on 2008-01-02 23:58:52

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Poster: johnnyonthespot Date: Jan 2, 2008 4:13pm
Forum: GratefulDead Subject: Re: gas and a pack of smokes

Interesting. I've never known anyone in the U.K. but I have talked to people in the Netherlands and in France and everyone I've ever met was completely satisfied.

One thing I know for sure is despite fear tactics I know for a fact it can work. Up here in Alaska they have what's called Denali Kid Care. Anyone who qualifies via income or doesn't have insurance coverage at their job, gets free coverage for their kids. FREE. And there's nothing substandard about it. Your kid gets sick, you take them to the Dr., and it's PAID. I pay for my insurance, I take my kid to the Dr., I pay 20% AFTER deductible. If there's anything new perscribed or if there's no generic option, they stick it to you. My ex took my son to the E.R. but because it wasn't where I work they dispute half the charges. I'm sorry but I become more and more disgusted everyday seeing insurance companies trump Dr.s. WTF do they even bother going to all those years of school for?

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Poster: Arbuthnot Date: Jan 2, 2008 4:56pm
Forum: GratefulDead Subject: Re: gas and a pack of smokes

Okay, from what i understand, the Netherlands (much like most if not all those countries in and around the Baltic Sea), don't really deal with the same demands and healthcare issues that England, and the continent has to deal with; for one thing, they have a far higher educated population, and the density of population is not so extreme, in other words more manageable; i'm not saying that's why they have a better healthcare setup, but it's food for thought anyway.

You say that the healthcare for lower-income and the uninsured children in Alaska is free; to a point, yes it's free in the sense that you are not paying anything for the coverage directly, however, i can almost be certain that the high rates you pay for YOUR health coverage is due to the health ins. companies and the gov't having to pick up the tab for the kids; so, it's not really free, someone is paying for it for sure.

And like the majority of healthplans today, they are networked or HMO based, meaning that you have only a certain (sometimes limited) number of facilities and doctors that you can go to in-network; if you go out of the network, you pay far more, even sometimes the entire bill if you don't have out-of-network benefits attached to your health plan. Even Medicaid, as beneficial as that is, is not all perfect in terms of coverage. For instance, if you are a Medicaid patient in the region where i live, there is only ONE facility that you can be seen for orthopedic care, and getting an appointment there is not so easy, and it is entirely referral based unless you are referred by the emergency room attached to the hospital that runs the orthopedic center. And in fact, many specialist doctors do not accept Medicaid patients (or other welfare products), unless they agree to pay as a self-pay, which isn't likely given that many are on Medicaid because they cannot afford to pay out of pocket for their healthcare. But the fact is, you can't just point the finger at the health ins. industry, or at the doctors or at the patients themselves; all are responsible to some degree for the state of healthcare; it's not perfect, but i can assure you that there are many countries outside the US i most definitely do not want to be in when in need of a doctor

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Poster: johnnyonthespot Date: Jan 2, 2008 8:36pm
Forum: GratefulDead Subject: Re: gas and a pack of smokes

Hey Arb, I have to respectfully say to you that you are wrong on this one. First of all I have private insurance that I pay for through my employer but I'll tell you I would gladly have Denali Kid Care if I could. I know first hand what they cover and the ONLY thing I have ever seen not covered was braces. Guess what? My plan that I PAY for does cover them at a way smaller portion ( barely ). And while this is a medicaid thype of program I guess, it's not an HMO. Anybody you want accepts the coverage. Anyone. As far as me paying for it one way or another.... just another free market theory. This is the same sort of theory that tries to make me believe all these frivolous lawsuits are to blame for my rates. They never mention all the legitimate lawsuits that get settled and/or squashed. The bottom line is that my rates won't decrease and neither will my tax burdon. I would rather my taxes go towards something I know first hand is a blessing to a LOT of people ( unfortunately not me )than a bunch of scumbag defense contractors.

What coverage do the politicians get? Are THEY turning it down? You don't by chance work in the insurance industry do you? That's the only group of people that I know that think we have a good system in this Country.

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Poster: Arbuthnot Date: Jan 2, 2008 9:32pm
Forum: GratefulDead Subject: Re: gas and a pack of smokes

johnny, as i said i'm no expert, i can just judge from my own perspective, and what i've picked up in the literature that i try to keep up on; as for how you describe the Denali coverage, i have no doubt it is accepted everywhere (i would suspect thought that a child seen outside of Alaska might run into some reimbursement problems ... Medicaid is state regulated, not federal), and i can almost guarantee that it is accepted by all the providers in your state due to statute, not because the medical providers are all-of-a-sudden struck by waves of altruism; and seriously, i am glad that you have that kind of coverage for the under- and non-insured children of your state, it makes it far less stressful on the parents knowing that their kids are covered for medical expenses; also, i realize that most (probably all ... not really sure) Medicaid products are not HMO regulated, however, some welfare plans are not accepted everywhere, as i mentioned in my previous post about specialist care in my area for Medicaid recipients; i agree that there are reasons thrown out to the public about why health insurance is so costly, and that frivolous lawsuits are often cited, however, i don't only work in healthcare, i work specifically in the legal side of healthcare, and i can assure you that frivolous lawsuits are a tiny percentage (probably around less than 4 or 5%) of what ends up in the courtroom, and so i agree with you that it is a bogus excuse, however, i must respectively disagree with you if you think that you are not in some manner (maybe not "you" specifically) paying the cost for that Denali coverage, either directly in taxation, or even perhaps in what you earn in salary ... maybe you would earn more if your employer didn't have to contribute financially to support the coverage; but to say it is "free" is ridiculous at best; there's nothing free in life, even stealing something is not free, as you pay in karmic/spiritual damage, my take anyway; if you have any complaints about what sort of benefits that the politicians receive in your state, well then, stop electing them or take up arms against them, or act to change the existing laws; i don't know what else to say about that, for the simple reason that politicians receive zero respect from me, but i do know that whether you are here or there or anywhere, whether stateside or abroad, politicians are all of the same ilk and you will hear the same complaints in every society, and so why burden your spirit (and health) with something that always has been and will likely always be; and rest assured my friend, i most certainly do not work for the insurance industy ... in fact, one aspect of my employment is making sure that the insurance companies pay the bills they are contracted to pay for; i've helped untold number of patients sleep better at night by resolving their nightmarish billing issues

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Poster: johnnyonthespot Date: Jan 3, 2008 12:25pm
Forum: GratefulDead Subject: Re: gas and a pack of smokes

Arb,

Your right about Denali Kid Care not being accepted outside the State but I must say you are wrong about a couple of things:

" and i can almost guarantee that it is accepted by all the providers in your state due to statute, not because the medical providers are all-of-a-sudden struck by waves of altruism;"

I don't know what the specific Statute is but I think it is widely accepted because they PAY the bills! Why wouldn't a healthcare facility want to get paid? I am not naive. Trust me, I have a very good knowledge how a NON profit Hospital works( even though Non profit to me means not taxed )so I can only imagine a for profit ( actually those don't seem to work as well up here ). Whatever their motivation, what does it matter? Medical bills can cripple an average person financially and I have a personal view that a society worth living in should not profit from peoples misfortions that are beyond their control. Again, I'm not naive about how this world works but I sure as hell am going to support something that supports my moral beliefs.

" i must respectively disagree with you if you think that you are not in some manner (maybe not "you" specifically) paying the cost for that Denali coverage, either directly in taxation, or even perhaps in what you earn in salary ... "

How does Salary get factored in this? My employer gets PAID 100% as opposed to whatever contested percent by private insurance ( like the shitty type of plan I have ) which ends up leading to non payment or payment plans of reduced amount. Then of course there's the price of having to treat the uninsured which definately could effect my salary but happens to be the exact opposite of my point.

You misunderstood my comment about being free. Here's the reality I see - someone like me who pays towards my premium every payday then pays a deductible for each of my kids THEN has had to get pre-authorization and was initially denied to get the medication prescribed to my son by THE top " specialist" in his field. Meanwhile I know of at least one person who took their kid to the same Dr. only they not only don't pay a premium, they were covered 100%. Kind of a no F'n brainer about which one a person would rather have don't you think? Kind of the exact opposite of what you describe. All of this proves to me that it CAN work. I'm tired of everyone's fear and excuses. I see it work. As far as paying with it in taxes, taxes aren't ever going down. I AM going to get taxed. Here's what I ask " conservatives" all the time - why is there NEVER enough money to invest in healthcare and education but Billions ans Billions of dollars to make bullshit wars that don't do anything but make defense contractors rich?

" if you have any complaints about what sort of benefits that the politicians receive in your state, well then, stop electing them or take up arms against them, or act to change the existing laws;"

Are you serious? I have a problem with the same whores who get and use FULL insurance coverage for life, working for the insurance and pharmaceutical companies trying to block us citizens from getting what they have. Back to your arguement about altruism, do you really think these entities are opposed to the evils of " socialized medicine" ( another right wing fear buzz word right up there with the word liberal ) because they give a flying F about the quality of our care? Or are they only in it for the money? And I do vote and I do get involved with things that I think are important. It's just a sad reality imo that the " working stiff" as you describe will continue to bare the brundt of the tax burdon and will continue to prop up the wealthy because they aren't involved and smart enough to see who's exploiting them. Just like a great Dylan lyric -

But the poor white man's used in the hands of them all like a tool.
He's taught in his school
From the start by the rule
That the laws are with him
To protect his white skin
To keep up his hate
So he never thinks straight
'Bout the shape that he's in
But it ain't him to blame
He's only a pawn in their game.


This post was modified by johnnyonthespot on 2008-01-03 20:23:38

This post was modified by johnnyonthespot on 2008-01-03 20:25:41

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Poster: Arbuthnot Date: Jan 3, 2008 7:39pm
Forum: GratefulDead Subject: Re: gas and a pack of smokes

well, as is so often the case in these non-dead exchanges, things generally get kinda wild and points get misconstrued and whatnot, but i rather have known that you are passionate about what you believe and about wanting a society that is healthier and happier and that's great, more people should have the same or similar approach to things; but i sometimes fear that a utopian vision for the world with everyone happily holding hands and singing and everything provided for is a futile goal, and personally one which makes me cringe; it reminds me of those old Star Trek episodes when the Enterprise would come to some planet and all was so seemingly perfect, everyone happy and smiling and healthy and the Enterprise crew so amazed and being suckered in about the whole utopian dream ... until of course the disease at the core of the society is exposed and the ugliness is unearthed

anyway, i guess i should say it really isn't right for me to comment on the healthcare in your state seeing as i don't live there and experience it first hand; i know the healthcare in my area and i was extrapolating from that; there are similarities among the state and federal plans of course; i do find it curious though that you believe the providers in your area get paid 100% for the Denali care, whereas i believe what you mean is that the providers get paid 100% of the allowable rate, meaning that you do not have to pay an out-of-pocket expense such as what you have to pay with your own coverage; and i am sure you must be aware that the "allowable rate" is not the amount that the provider charges for the service, but is in fact the contracted agreed reimbursment; SDH has it right ... more and more providers are opting out of accepting Medicaid patients because not only is the reimbursement too low, but for every Medicaid patient a provider sees, they actually are losing money as a business; it's a little known fact, but it is accurate; if in fact the medical providers do in fact receive 100% reimbursement on what they charge from the Denali coverage, i would be amazed since it is rare for any insurance company to pay at 100% of the charged amount; however, until i can see some EOBs for services rendered, we'll have to disagree

the difference really between our thought processes Johnny, is that you see hope in the left, whereas i see no hope in neither the left or right, never have

This post was modified by Arbuthnot on 2008-01-04 03:39:36

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Poster: Arbuthnot Date: Jan 3, 2008 4:43pm
Forum: GratefulDead Subject: Re: gas and a pack of smokes

just as i thought, payment is not at 100% of the charged amount, but at the rate that is set by the state (and when has a state ever paid more than they absolutely have to pay); from the Alaska "State Plan for Title XIX":

Methods and Standards for Establishing Payment Rates:

Other Types of Care
Physician Services

Payment is made at the lesser of billed charges, the Resource Based Relative Value Scale (RBRVS) methodology, the provider’s lowest charge, or the state maximum allowable for procedures that do not have an established Relative Value Unit (RVU). The Resource Based Relative Value Scale methodology is that described in 42 CFR 414 except that increases and reductions to the average payment made for an individual procedure code billed at least ten times during the previous fiscal year will be phased in until the year 2000. The relative value units used are the most current version published in the Federal Register. Non-routine office supplies are reimbursed at the lesser of billed charges or the state maximum allowable.

Payment for the services of a physician collaborator is made at the lesser of billed charges, 85 percent of the Resource Based Relative Value Scale methodology, the provider’s lowest charge, or the state maximum allowable for procedures that do not have an established RVU. Physician collaborators are a physician assistant, advanced nurse practitioner, physical therapist, occupational therapist, audiologist, speech language pathologist, certified registered nurse anesthetist, or a community health aide III or IV or a community health practitioner certified by the state.

Surgical reimbursement is in accordance with the Resource Based Relative Value Scale methodology except that multiple surgeries performed on the same day are reimbursed at 100 percent of the RBRVS rate for the highest procedure and 50 percent of the RBRVS rate for each additional surgery; bilateral surgeries are reimbursed at 150 percent of the RBRVS rate; co-surgeons are reimbursed by increasing the RBRVS rate by 25 percent and splitting payment between the surgeons; and supplies associated with surgical procedures performed in a physician’s office are reimbursed at the lesser of billed charges or the state maximum allowable. Payment is made to surgical assistants at the lesser of billed charges or 25 percent of the Resource Based Relative Value Scale methodology.

Laboratory services are reimbursed at the lesser of the amount billed the general public or the Medicare fee schedule. Prescription drugs dispensed by a physician are reimbursed at 95% of the Average Wholesale Price (AWP) without a dispensing fee.

Payment is made to independently enrolled hospital-based physician for certain services at the lessor of the amount billed the general public or 100 percent of the Resource Based Relative Value Scale methodology.

Anesthesia services are reimbursed using base units and time units and a state determined conversion factor.

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Poster: johnnyonthespot Date: Jan 3, 2008 9:06pm
Forum: GratefulDead Subject: Re: gas and a pack of smokes

" the difference really between our thought processes Johnny, is that you see hope in the left, whereas i see no hope in neither the left or right, never have"

Arb, I have allways known you to be an upright honest righteous guy. I am disappointed that you are being what seems to me be a little condescending. We haven't even spoken enough for you to speak about what my thought process is. I can't believe you would be so presumptuous. You don't know what my political affiliation is. I mentioned my opposition to the right as it pertains to this particular issue. For the record I am undeclared and have no party loyalty.Here is my political leaning - it depends on the issue. I think of myself more as a pragmatist. What's the issue, what has proven to work, what can be realistically improved upon, what's the best way to solve a problem. I see the Healthcare in this Country and how it effects people I care about as a problem.

As I think we both agree, this is a complex issue. Ok, I was wrong, they don't get reimbursed 100%.
I have no illussions of Utopia man, all I know is that I would love to pay what I pay now ( or even more ) and know that I can take my kid to the Dr. without it causing my entire family grave financial hardship even AFTER my premium and deductable are met. Talk all you want about the hardships of the medical providers while I see first hand how they build their real estate empires to hide their " profits"

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Poster: Arbuthnot Date: Jan 3, 2008 9:52pm
Forum: GratefulDead Subject: Re: gas and a pack of smokes

sorry J., you're right of course, it was presumptuous of me, no hard feelings my friend, topics much like the one we bantered about on are best left to the experts, of which i am most definitely not one; cheers

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Poster: johnnyonthespot Date: Jan 4, 2008 6:41am
Forum: GratefulDead Subject: Re: gas and a pack of smokes

no hard feelings. Who are the experts though? I hope not the people who profit from this.

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Poster: high flow Date: Jan 3, 2008 11:32pm
Forum: GratefulDead Subject: Re: gas and a pack of smokes

T - Are you famliar with word stammtisch? It is a place that is missing in America. But we have one right here. Prost.



This post was modified by high flow on 2008-01-04 07:32:57

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Poster: SomeDarkHollow Date: Jan 3, 2008 12:13pm
Forum: GratefulDead Subject: Re: gas and a pack of smokes

I've been watching this exchange and figured I'd throw my two cents in. I work in the insurance field from a Public Payer and patient assistance angle (with a heavy focus on state and federal public assitance programs). First off, individual providers are not required in any state to accept Medicaid or CHIP patients (just like they don't have to accept Medicare Part B folks either). In the past, almost all doctors accepted most publically funded insurance programs; but now this number is starting to shrink as these programs are reducing the amount of money the providers are reimbursed for various procedures(Medicare and Medicaid most of all).
Medicaid is primarily state run, but there are some core statutes that they must adhere to if they want to receive Federal Matching funds. These include specific folks that must be covered and what the programs actually cover (as you mentioned, state Medicaid programs are not required by Federal Law to cover dental care, although most do). There are optional benefits and coverage groups that states can elect to cover and still qualify for additional matching funds from Uncle Sam (prescription meds are included in this group...it is plausible that a state Medicaid program could elect to cease covering prescription meds). CHIP programs, of which Denali KidCare is one, can either be direct offshoots of Medicaid, or seperate entities entirely, run by private companies who accept a lump sum per covered child from the state each year. Denali KidCare is a direct offshoot of Alaska Medicaid and provides medical coverage to children of families whose income may exceed that of qualification for standard Medicaid (standard Medicaid provides coverage to children under 19 whose family income does not exceed 175% of the Federal Poverty Limit, while Denali covers the same kids whose family income is between 186 and 200% of the FPL). The program targets families who may be employed and even offered health covereage by their employer, but whose income makes the cost of such coverage prohibitive.
As for "Free", well, like its been said, what is free anymore? Denali KidCare is funded with a combination of State and Federal funds (primarily Federal). So when you see your paycheck with the big chunk taken by Uncle Sam and your state, a portion of that DOES end up funding some of these programs. States have the option of expanding coverage using entirely their own funds, the biggest source being the "sin taxes". The recent cluster fuck on capital hill had to do with this expanded coverage. Dems wanted the Feds to contribute matching funds for expanded coverage (such as increasing the income limits for children or offering coverage to their parents). But this ended this past weekend when W signed legislation that only provides funding for keeping the program as is.

OK, that may be of my most "un-dead" offerings. Sorry.

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Poster: high flow Date: Jan 3, 2008 12:43pm
Forum: GratefulDead Subject: Re: gas and a pack of smokes

From the Peanut Gallery....

Pay thru the nose for piss-poor service. That's my reality.

In the very recent past, I had a cancer scare. We had to jump through hoops, run the gamut and ride the pass of death, just to get a preliminary diagnosis.

Good news is, no cancer.

Bad news is, because this experience/service was so awful, I fear illness more than ever.

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Poster: SomeDarkHollow Date: Jan 3, 2008 12:48pm
Forum: GratefulDead Subject: Re: gas and a pack of smokes

First off, and most importantly, I very happy to hear that it wasn't the Big C.

Second, my company does a lot of work with helping folks obtain coverage from their insurance for expensive treatment, or finding funding if they are un-insured. I definitely am exposed to the dark underbelly of the healthcare system in this country on a daily basis. Unless there is some major changes made, we will certainly see the system collapse in on itself within the next 50 years (probably less). Folks are rightly concerned with the state of Social Security, but the health of the healthcare system in this country should take precedence.

OK, enough happy talk.

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Poster: johnnyonthespot Date: Jan 3, 2008 9:53pm
Forum: GratefulDead Subject: Re: gas and a pack of smokes

High Flow my friend, I second SDH on being very glad it wasn't cancer

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Poster: johnnyonthespot Date: Jan 3, 2008 12:47pm
Forum: GratefulDead Subject: Re: gas and a pack of smokes

SDH - don't you think it's a great program? I do and I don't even get to benefit from it.

As i've said - I don't believe my taxes will go down by eliminating programs that I know for a fact benefit people, honest working people too. Why wouldn't I support that?

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Poster: SomeDarkHollow Date: Jan 3, 2008 12:55pm
Forum: GratefulDead Subject: Re: gas and a pack of smokes

I think the CHIP programs are one of the best things to come out of the Clinton administration. We keep kids healthy, everyone benefits, both "spiritually" and economically. The amount we "chip" in (ha-ha), is much less than the actuall savings we get by having healthier kids in a group that was traditionally the sickest. I love the program and am just glad that it has at least secured funding to continue for a couple of years more.

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Poster: johnnyonthespot Date: Jan 3, 2008 1:11pm
Forum: GratefulDead Subject: Re: gas and a pack of smokes

don't you also think that it's proof that it could work for everyone? That it's possible? I know healthcare is complicated, it's just hard for me to listen to this fear tactic of people waiting in a breadline type atmosphere not getting care when I see first hand how it can work.

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Poster: Earl B. Powell Date: Jan 2, 2008 7:11pm
Forum: GratefulDead Subject: Re: gas and a pack of smokes

Right on Arb! This is one area of our lives where a conspiracy is not just a theory, but a genuine bonafide matter of fact. Greasy palms all around and the consumer gets the short end of the stick at every turn. It's a three way battle to see who gets to scrape up the most funds after the butchering gets done. The government, the healthcare providers and the jackals of the insurance trade in the biggest and most corrupt circle jerk on the planet. Throw in a gaggle of the finest lobbyists money can buy and you have a recipe for robbery.

Don't get me started.

BTW. $2.73 a gallon yesterday and $2.84 for a pack of Winstons here in South Carolina. I love smoking and driving.

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Poster: Arbuthnot Date: Jan 2, 2008 7:47pm
Forum: GratefulDead Subject: Re: gas and a pack of smokes

believe me, Earl, outside of music & lit, healthcare is one topic i can talk about all day, but unlike music & lit, pondering healthcare generally makes me want to break something; i honestly cannot think of any other industry that is more complex and with as many tentacles reaching into practically every area of our lives; is the answer a form of socialized medicine, and can such a setup work in the type of economy that the US has? i've no idea of course, but either way, whether socialized medicine or not, the working stiff will continue to be stiffed; cheers

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Poster: Earl B. Powell Date: Jan 2, 2008 8:07pm
Forum: GratefulDead Subject: Re: gas and a pack of smokes

Arb: I have a very simple approach to issues like this; If you are in business, any kind of business, even the business of governing, someone must pay your company in order for it to survive. Supply side economics believe that in a healthy economy, money will "trickle down" to those in need of it most. While this theory has never been universally embraced, I can assure you that "the cost of doing business" will always trickle down to those that can least afford it.

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Poster: daliguana Date: Jan 2, 2008 4:30pm
Forum: GratefulDead Subject: Re: gas and a pack of smokes

Down here in New Mexico, gas is just over $2.85, and pack of American Spirits comes in at $5.05. I'm with you, JOTS, down to one-a-day for years, except when I drink, then may smoke 3 or 4. No smoking at any public place, ie bars, restaurants. Good thing if you ask me. While in school, my family and I qualify for both foodstamps and health care. We're on medicaid and it pays for all Dr appts and dental, and new glasses every other year. We're pretty happy with the coverage. We get $400 a month in foodstamps, too, which helps as well.

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Poster: AshesRising Date: Jan 3, 2008 9:32pm
Forum: GratefulDead Subject: Re: gas and a pack of smokes

.. i'm just grateful that I've never had to deal with anything involving health care...

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Poster: johnnyonthespot Date: Jan 3, 2008 9:51pm
Forum: GratefulDead Subject: Re: gas and a pack of smokes

you will. hope for the best

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Poster: Arbuthnot Date: Jan 4, 2008 9:32pm
Forum: GratefulDead Subject: Re: gas and a pack of smokes

the irony is killing me though